Form 1052 Public Provider Choice Request - Texas

Form 1052 Public Provider Choice Request - Texas

What Is Form 1052?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1052?
A: Form 1052 is the Public Provider Choice Request form used in Texas.

Q: What is the purpose of Form 1052?
A: The purpose of Form 1052 is to request a change in public provider for healthcare services in Texas.

Q: Who can use Form 1052?
A: Any individual who receives healthcare services from a public provider in Texas can use Form 1052.

Q: How do I fill out Form 1052?
A: You need to provide your personal information, current public provider details, and the name of the new public provider you wish to choose.

Q: Is there a deadline for submitting Form 1052?
A: There is no specific deadline mentioned for submitting Form 1052, but it is recommended to submit it as soon as possible.

Q: Can I change my public provider multiple times using Form 1052?
A: Yes, you can change your public provider multiple times using Form 1052.

Q: What happens after I submit Form 1052?
A: After submitting Form 1052, your request for a change in public provider will be processed by the Texas Department of Health and Human Services.

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Form Details:

  • Released on February 1, 2023;
  • The latest edition provided by the Texas Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 1052 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

Download Form 1052 Public Provider Choice Request - Texas

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